Doctors conflicted about reporting drug-abusing colleagues

Hypothetical situation: You're a doctor and discover a colleague has a drug problem. Do you report him?

One in three doctors wouldn't, according to a new survey published today in the Journal of the American Medical Association.

Those who actually faced this scenario and didn't take action said they believed someone else was addressing the problem, or nothing would happen as a result. Others feared retribution or that their colleague would be punished excessively.

"We refer to it as the conspiracy of silence," said Dr. Scott Teitelbaum, the medical director of the Florida Recovery Center in Gainesville, which treats doctors with substance-abuse issues."Doctors think that if they intervene, instead of saving a life, they will hurt a career. There's a tendency to protect the guys."

Underrepresented minorities, doctors from international medical schools and doctors in small private practices were the least likely to report a colleague.

Of the 3,500 physicians who received the survey, 64 percent responded. That leads study authors to believe they are probably over-estimating the number of doctors willing to report their colleagues, and that the problem is actually larger than the survey reflects.

Florida's approach

In Florida, doctors with substance-abuse problems are either reported to or check themselves in to the Professionals Resource Network, an intervention program in which they stop practicing and undergo rehabilitation. Once they're clean, says Teitelbaum, they can go back to practice.

The reporting system in Florida is more forgiving than most states. Only seven others have medical boards less punitive than Florida's, which carries out 2 disciplinary actions for every 1,000 physicians. Alaska tops the list with about 8 actions per 1,000. The national average is 3 in 1,000.

Contributing to Florida's low disciplinary rate could be thesafety net provided by Professional Resource Network, which rehabilitates health-care workers before they slip up and harm a patient, said Dr. John Fromson, a psychiatry professor at Harvard Medical School and co-author of the study.

"Some people would say the board is not doing their job, but others might say the board is doing a great job doing preventative programs, education and outreach," said Fromson.

Despite Florida's safety net, Teitelbaum said doctors here are still scared of bringing down a colleague's career. But career is usually the last part of their life to crumble under addiction, said Teitelbaum.

"The job is the last thing to go. Family life, spiritual life, everything goes first," said Teitelbaum. "It's a misconception about the illness."

That's why early intervention, especially colleagues reporting, can save a career rather than protect it, according to Teitelbaum.

In the JAMA survey, 17 percent of the doctors surveyed knew an impaired or incompetent physician. Of those, two-thirds reported the offender.

There needs to be both confidentiality for the whistle-blower and a feedback system so the reporter knows what happened, said the study's lead author, Dr. Catherine DesRoches, a health-policy researcher at Massachusetts General Hospital.

"They could have evidence that the report made a difference," said DesRoches.

Reporting and treating

Women are more likely to agree it is their professional responsibility to report colleagues, but said they felt less prepared than men to deal with incompetent colleagues.

Physicians who run their own practices, or with a partner, were the least likely to report a colleague. The reason may be two-fold, says DesRoches: They might not want to bring down their own practice by reporting a partner, or the type of physician who runs a private practice has different attitudes about reporting.

Those who have practiced the longest — more than 30 years — are less likely to report colleagues than those with fewer than 10 years of experience. That might be because substance-abuse problems crop up later in a doctor's career in their 50s or 60s, speculates Fromson. At that point,doctors can turn to alcohol to become more sociable as they try to rekindle relationships with their significant others or children.

At the Florida Recovery Center, about 80 to 90 percent of doctors return to work after being treated. But some doctors come back a second time. And a third.

"Perhaps they need a different kind of treatment," said Teitelbaum. "Instead of punishing them, we say: You can't return to your practice yet."

One physician who had been treated more than once left his practice and worked at a home-construction store. After a year, he returned to his practice. "Totally clean," said Teitelbaum.

The prevalence of addiction among physicians is similar to that in the general population, he said.

"The illness doesn't care that you're a brilliant physician," said Teitelbaum. "I tell my patients, 'Your illness is no different than the guy sweeping the floor in the emergency room.' It'll take you down the same way."